Methods and Materials: 15 pts. (11 men) aged 54.2  20.2 yrs. with Stage C, NYHA Class I-IV HF had treadmill cardiopulmonary exercise tests (CPX). Change in slope was defined as VE/VCO2 slope at P minus the slope at AT. Cardiac events included LVAD implant, cardiac transplant and transplant listing. We recorded data on death, ER admissions, office visits, NYHA class, days of using IV medications (inotropes/vasodilators or diuretics) in the yr prior to and following CPX. Results: No pt. died; 2 pts. had events (1 LVAD implant and 1 cardiac transplant list). Decline in slope was shown to be a predictor of events and regression analysis showed a negative correlation between the decline in slope and cardiac events (Multiple R = 0.703; p = 0.0034). Regression analyses compared P-AT with pt. data for the yr prior and time since CPX. Though P-AT did not correlate with NYHA class in the yr prior to testing (p=0.264), it did with NYHA class after testing (p=0.0313). No correlation was found between P-AT and ER admissions or office visits. Significant relationships were found with inotropes/vasodilators both before (p= 0.002) and after testing (p= 0.0008), but not with diuretics. Conclusions: In pts. with HF, decline in VE/VCO2 slope beyond AT is a potent predictor of need for LVAD/heart transplant listing. This descriptor does not seem to be correlated with other markers of advancing HF. The VE/VCO2 slope and its change beyond AT provides important prognostic information and may be an early poor prognostic marker that can distinguish a particularly high-risk popu- lation of HF patients. 240 Evaluation of the Seattle Heart Failure Model in 150 LVAD Recipients S.K. Prakash, 1 W.C. Levy, 2 B. Radovancevic, 3 O.H. Frazier, 3 R.C. Bogaev, 1,3 1 Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX; 2 Cardiopulmonary Transplantation, Texas Heart Institute, Houston, TX; 3 Department of Medicine, Section of Cardiology, University of Washington, Seattle, WA Purpose: Estimated length of survival is one of the most important factors that determine when patients with severe heart failure are referred for device therapy or transplantation. Until recently, clini- cians had few reliable tools to predict the life expectancy of heart failure patients. To address this, the Seattle Heart Failure Model (SHFM), which synthesizes 34 clinical parameters into a score pre- dicting the survival of ambulatory heart failure patients, was devel- oped. However, the populations used to validate the model did not include stage D patients with advanced heart failure, who do not survive without intensive care, left ventricular assist devices (LVADs) or urgent transplantation. This subgroup will increase with the rising incidence of heart failure. Our study was intended to evaluate the SHFM in stage D patients. Methods and Materials: We conducted a retrospective chart review of 150 consecutive patients (124 male, 26 female) who were im- planted with pulsatile and continuous-flow LVADs at the Texas Heart Institute from September 4, 2002 to September 1, 2007. Patients who underwent LVAD exchanges were excluded. Results: The mean ejection fraction was 18% and the mean systolic blood pressure was 103 mm Hg. The predictive one year survival of our population, based on the SHFM, was 35.5%. 86% of patients had a predictive survival of less than 50% at 2 years. The mean survival time was 394 (0-1627) days. Kaplan-Meier survival on LVAD support was 59.5 %, 53.4%, 47.4% at 180 days, 1 year, and 2 years. The estimated hazard ratio at 2 years is 0.48. (p0.001). Conclusions: The SHFM confirms that LVAD support dramatically improves survival in this high-risk cohort of patients. The SHFM can be utliized to identify patients who would benefit from LVAD therapy. 241 Outcomes of Patients Declined for Cardiac Allograft Transplantation I. Halaweish, 1 D. Taylor, 3 R. Starling, 3 G. Gonzalez-Stawinski, 2 1 School of Medicine, Case Western Reserve University, Cleveland, OH; 2 Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH; 3 Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH Purpose: Heart transplantation has become standard therapy for end-stage heart failure in carefully selected patients. The limitation in the number of donor organs available necessitates a vigorous evalua- tion process for patient selection. There is little knowledge regarding the short- and long- term outcomes of patients referred for heart transplantation evaluation and denied due to existing contraindica- tions. Methods and Materials: We performed a retrospective review of 210 patients evaluated and denied after evaluation for heart transplan- tation at our institution between January 2000 and May 2007. Variables collected for analysis included demographics, reasons for decline, and short- and long-term outcomes. Results: The mean age was 53.7 years (17-77 years) with a male to female ratio of 4.1:1. The most common etiology of heart failure included ischemic cardiomyopathy in 120 (57%) and dilated cardio- myopathy in 71 (34%). 145 (69%) patients were in NYHA class III, 40 (19%) were in NYHA class II, and 25 (12%) were in NYHA class IV. Common reasons for declining included 52 % declines due to psycho-social reasons, and 21 % because of being judged too well for listing. However, most patients were denied because of multiple reasons. For instance, 54 (25.7%) patients were denied for two reasons, 27 (12.9%) for three reasons, and 25 (11.9%) were denied for four or more reasons. Overall patient survival at a mean follow-up of 2.4 years was 41%. Mean survival for patients deemed too well was 67% compared to 39% and 20% for NYHA class III and IV patients respectively. Survival for patients discharged with inotrope therapy was merely 29%. Post declination, 28 patients (13%) were listed elsewhere and 14 (6.7%) were ultimately transplanted at other centers. Conclusions: In this single center study, most patients who are deemed to well for transplantation survive with medical management; however, a significant proportion of patients go on to being listed and then transplanted at outside facilities. 242 Validation of a Cutoff Value on Echo Doppler To Replace Right Heart Catheterization during Pre Transplant Pulmonary Hypertension Evaluation. The Impact of a Noninvasive Study A.F. Freitas, Jr., 1 F. Bacal, 1 L.F.P. Moreira, 1 C.P. Silva, 1 S. Mangini, 1 R. Honorato, 1 J.L. Oliveira, Jr., 1 A.I. Fioreli, 1 R.M.D. Carneiro, 1 N.A.G. Stolf, 1 E.A. Bocchi, 11 Heart Failure Department, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil Purpose: Right heart catheterization (RHC) should be performed on all candidates in preparation for listing for cardiac transplantation (CT). Noninvasive methods are still not reliably accurate to evaluate all components (PsAP, TPG and PVR) of pulmonary hypertension (PH). We determined and validated a cutoff value of a echo Doppler parameter capable to replace RHC on diagnosis of PH. Methods and Materials: 130 patients (mean age:4215 years, 72 men) with advanced heart failure (HF) (mean EF: 2912%, functional class III-IV) were simultaneously submitted to a RHC with measure- ments of pulmonary parameters (PsAP, TPG and PVR) and noninva- sive estimation of right sided pressures from Doppler recordings of The Journal of Heart and Lung Transplantation Abstracts S147 Volume 27, Number 2S